Pain Flashcards
Which of the following agents is not used for opioid-induced constipation (OIC)?
Answer
A Relistor B Amitiza C Narcan D Belbuca E Movantik
D
Belbuca
Incorrect
The periperally-acting mu-opioid receptor antagonists (PAMORAs) are used for OIC, as is naloxone (off-label) and lubiprostone.
A patient receiving a non-selective non-steroidal anti-inflammatory drug (NSAID) long-term should receive the following counseling point/s. (Select ALL that apply.)
Answer
A
The medication is safe to use in heart failure if the patient does not exceed recommended doses.
B
If the patient has hypertension he/she should limit salt intake to less than 5 grams of sodium/day.
C
Limit sun exposure and wear protective clothing and sunscreen.
D
This medication should be taken with food to help reduce nausea.
E
Monitor stool color; if it turns dark and “tarry” looking, the patient may have stomach bleeding.
C
Limit sun exposure and wear protective clothing and sunscreen.
D
This medication should be taken with food to help reduce nausea.
E
Monitor stool color; if it turns dark and “tarry” looking, the patient may have stomach bleeding.
Incorrect
Black, tarry stool can indicate bleeding further up in the GI tract, and may be due to ulceration of the stomach lining. Instruct the patient that this is an emergency, as is “coffee ground” emesis, or vomiting up digested blood particles.
Which of the following signs and symptoms would be present in a patient who has received an overdose of Dilaudid? (Select ALL that apply.)
Answer
A Sedation B Shallow breathing, faint breath sounds C Cold and clammy skin D Tachypnea E Pinpoint pupils
A Sedation B Shallow breathing, faint breath sounds C Cold and clammy skin
E
Pinpoint pupils
Which of the following medications and doses are roughly equivalent to 30 mg of oral morphine?
Answer
A 10 mg oral hydrocodone B 10 mg IV oxycodone C 10 mg IV morphine D 7.5 mg IV hydromorphone E 1.5 mg oral hydromorphone
C
10 mg IV morphine
Incorrect
The conversion ratio for morphine IV:PO is 1:3. Oxycodone is not available in an IV formulation.
A 69 year-old female patient asks her doctor for Demerol and states that nothing else works as well for her chronic pain. She has pain that is rated as 8 or 9 out of 10, on a daily basis. The patient has renal insufficiency, with a creatinine clearance estimated at 23 mL/min. Choose the correct statement.
Answer
A
The patient is not a candidate for opioid therapy.
B
The patient can receive the medication, but is limited to 300 mg daily.
C
The patient can receive the medication, but is limited to 200 mg daily.
D
The patient can receive the medication, but is limited to 100 mg daily.
E
The patient should not receive this medication for chronic pain control.
E
The patient should not receive this medication for chronic pain control.
Incorrect
Meperidine (Demerol) is not appropriate for chronic pain control due to the short duration of action (it lasts about 3 hours) and due to the risk of neurotoxicity (including seizures) if the drug accumulates. This is of particular risk with renal insufficiency; it is not used with renal impairment.
JS has been hospitalized for many months receiving chemotherapy. He is stabilized and his pain is manageable on Dilaudid 2 mg IV Q3H. In anticipation of discharge, the medical team would like to convert him to an oral pain medication regimen. The palliative care physician wants to switch to MS Contin Q12H. How many milligrams of MS Contin PO Q12H is equivalent to JS’s current Dilaudid regimen? (Answer must be numeric; no units or commas; round final answer to the nearest WHOLE number.)
160
A pharmacist receives a prescription for Yosprala. This combination drug contains the following two individual agents:
Answer
A Naproxen and sumatriptan B Ibuprofen and sumatriptan C Naproxen and esomeprazole D Aspirin and omeprazole E Esomeprazole and sumatriptan
D
Aspirin and omeprazole
NSAIDs have boxed warnings related to which of the following serious adverse effects and conditions? (Select ALL that apply.)
Answer
A
GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines.
B
Cardiovascular thrombotic events, myocardial infarction, and stroke, possibly within the first weeks of use.
C
Risk of severe rash, including SJS and TEN.
D
NSAIDs are contraindicated for peri-operative pain management in patients receiving coronary artery bypass graft surgery.
E
Risk of certain types of cancer, including skin cancer and lymphomas.
Incorrect
Although there is not a boxed warning for severe rash, there have been cases of SJS in recent years from the use of ibuprofen and acetaminophen. Even these relatively safe agents are dangerous in some patients.
A
GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines.
B
Cardiovascular thrombotic events, myocardial infarction, and stroke, possibly within the first weeks of use.
D
NSAIDs are contraindicated for peri-operative pain management in patients receiving coronary artery bypass graft surgery.
Incorrect
Although there is not a boxed warning for severe rash, there have been cases of SJS in recent years from the use of ibuprofen and acetaminophen. Even these relatively safe agents are dangerous in some patients.
A patient has been prescribed Tylenol #3. She comes to the pharmacy window and is heard with a hacking cough and congestion. Choose the correct statement.
Answer
A
The drug has a high risk of nausea and can worsen or cause constipation.
B
It may increase her coughing and pulmonary congestion.
C
Patients who are poor metabolizers of CYP 450 2D6 may have increased analgesia.
D
The combination contains hydrocodone and acetaminophen.
E
Tylenol #3 cannot be used in patients with acute viral illness.
A
The drug has a high risk of nausea and can worsen or cause constipation.
Incorrect
Tylenol #3 contains codeine and acetaminophen. Codeine can cause significant GI distress. It is used as an antitussive (to decrease cough) in cough syrups. Patients who are rapid metabolizers of 2D6 will have higher levels of morphine.
JM was in an auto accident six months ago. He suffered a traumatic brain injury with resultant seizures. He has been receiving phenytoin to prevent further seizures. His other medications include metoprolol extended-release (for hypertension) and citalopram (for depression). JM was taking ibuprofen for pain, but the pain control has been poor and his stomach upset has become unbearable. Choose the most appropriate treatment option for pain control for this patient at this time:
Answer
A Tramadol B Meperidine C Fentanyl patch D Piroxicam E Hydrocodone-Acetaminophen
E
Hydrocodone-Acetaminophen
Incorrect
Tramadol and meperidine cannot be used in patients with risk of seizure, and meperidine is not used for chronic pain management. Fentanyl can be used in patients who have used other opioids first, but it is not indicated for initial opioid therapy. This patient may not need a full opioid agonist at this point.
A patient developed trouble breathing with laryngospasm after receiving an injection of morphine in the hospital. Which of the following agents would not present a cross-reaction for this type of allergy? (Select ALL that apply.)
Answer
A Fentanyl B Methadone C Meperidine D Tapentadol E Oxymorphone Incorrect
A Fentanyl B Methadone C Meperidine D Tapentadol
The US tapentadol labeling does not include a contraindication for patients who have an opioid allergy of the morphine type. The package insert for tramadol does have this contraindication and the two drugs are structurally similar. It may be good to know that tapentadol is not thought to interact.
An elderly gentleman has been taking tramadol 50 mg 5-8 times daily for 12 months for back and joint pain. The patient also used lorazepam 1 mg 4-5 times daily over the same time period. If the patient attempts to stop either of these medications, he will experience shakiness, agitation and tachycardia due to which of the following?
Answer
A Pseudo-addiction B Opioid hyperalgesia C Physiological adaptation D Addiction, which is a common problem among opioid and benzodiazepine users E Tolerance
C
Physiological adaptation
Incorrect
Addiction implies a psychological need to use the drug, such as getting a “high” from the drug. All patients using enough opioids (or benzodiazepines or barbiturates) will develop physical dependence if used chronically at regular dosing intervals.
EJ has been using oxycodone immediate release for pain management (as-needed) for the past several months. She cannot swallow most pills and crushes her medications. The physician wishes to provide better pain control and will use a long-acting medication. Which of the following medications represent possible options?
Answer
A Roxanol B Dilaudid C MS Contin D Kadian E Roxicodone
D
Kadian
Long-acting opioid tablets cannot be crushed; this could be fatal. Kadian and Embeda (morphine + naltrexone) are long-acting morphine capsule formulations that can be opened, but the beads cannot be chewed (or crushed in any way). Roxanol is no longer branded, but refers to the immediate release morphine solution.
Which of the following agents have a boxed warning to avoid any amount of alcohol as it could result in fatal respiratory depression due to increased absorption? (Select ALL that apply.)
Answer
A Norco B Soma C Zohydro D Opana ER E Nucynta ER
C Zohydro D Opana ER E Nucynta ER Incorrect Alcohol use should be avoided with any opioids, but with these agents the opioid level could become toxic (fatal).
Practitioners prescribing methadone must be familiar with the safe use of this narcotic. Methadone requires special safety considerations due to which of the following factors? (Select ALL that apply.)
Answer
A
High potential for abuse; never dispense to a patient with an addiction problem.
B
It can increase testosterone levels leading to aggressive behavior.
C
Difficult equianalgesic dose conversion.
D
Variable duration of action (half-life).
E
Risk for QT prolongation, especially at higher doses.
C Difficult equianalgesic dose conversion. D Variable duration of action (half-life). E Risk for QT prolongation, especially at higher doses. Incorrect Methadone is commonly prescribed, but requires expertise to dose properly. QT prolongation is an important issue with methadone.
